Skip to main content

Advertisement

SpringerLink
Log in

Differences by HIV serostatus in coronary artery disease severity and likelihood of percutaneous coronary intervention following stress testing

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected persons; however, the role of non-invasive testing to stratify CAD risk in HIV is not well defined.

Methods and results

Patients were selected from a single-center electronic cohort of HIV-infected patients and uninfected controls matched 1:2 on age, sex, race, and type of cardiovascular testing performed. Patients with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included. Logistic regressions were used to assess differences by HIV serostatus in two co-primary endpoints: (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance of percutaneous coronary intervention (PCI). HIV-infected patients (N = 189) were significantly more likely to undergo PCI following abnormal stress test when compared with uninfected persons (N = 319) after adjustment for demographics, CAD risk factors, previous coronary intervention, and stress test type (OR 1.85, 95% CI 1.12-3.04, P = 0.003). No associations between HIV serostatus and CAD were statistically significant, although there was a non-significant trend toward greater CAD for HIV-infected patients.

Conclusions

HIV-infected patients with abnormal cardiovascular stress testing who underwent subsequent coronary angiography did not have a significantly greater CAD burden than uninfected controls, but were significantly more likely to receive PCI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

Abbreviations

ART:

Antiretroviral therapy

CAD:

Coronary artery disease

CVD:

Cardiovascular disease

EHR:

Electronic health records

HIV:

Human immunodeficiency virus

LAD:

Left anterior descending artery

LCx:

Left circumflex artery

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

RCA:

Right coronary artery

References

  1. Butt AA, Chang CC, Kuller L, Goetz MB, Leaf D, Rimland D, et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Arch Intern Med 2011;171:737-43.

    PubMed  PubMed Central  Google Scholar 

  2. Chow FC, Regan S, Feske S, Meigs JB, Grinspoon SK, Triant VA. Comparison of ischemic stroke incidence in HIV-infected and non-HIV-infected patients in a US health care system. J Acquir Immune Defic Syndr 2012;60:351-8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Currier JS, Lundgren JD, Carr A, Klein D, Sabin CA, Sax PE, et al. Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation 2008;118:e29-35.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013;173:614-22.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Hsue PY, Deeks SG, Hunt PW. Immunologic basis of cardiovascular disease in HIV-infected adults. J Infect Dis 2012;205:S375-82.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Paisible AL, Chang CC, So-Armah KA, Butt AA, Leaf DA, Budoff M, et al. HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. J Acquir Immune Defic Syndr 2015;68:209-16.

    Article  PubMed  Google Scholar 

  7. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab 2007;92:2506-12.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Tseng ZH, Secemsky EA, Dowdy D, Vittinghoff E, Moyers B, Wong JK, et al. Sudden cardiac death in patients with human immunodeficiency virus infection. J Am Coll Cardiol 2012;59:1891-6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aboud M, Elgalib A, Pomeroy L, Panayiotakopoulos G, Skopelitis E, Kulasegaram R, et al. Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study. Int J Clin Pract 2010;64:1252-9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Edwards-Jackson N, Kerr S, Tieu H, Ananworanich J, Hammer S, Ruxrungtham K, et al. Cardiovascular risk assessment in persons with HIV infection in the developing world: comparing three risk equations in a cohort of HIV-infected Thais. HIV Med 2011;12:510-5.

    Article  PubMed  CAS  Google Scholar 

  11. Friis-Moller N, Thiebaut R, Reiss P, Weber R, Monforte AD, De Wit S, et al. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil 2010;17:491-501.

    Article  PubMed  Google Scholar 

  12. Moreira Guimaraes M, Bartolomeu Greco D, Ingles Garces AH, de Oliveira AR Jr., Bastos Foscolo R, de Campos Machado LJ. Coronary heart disease risk assessment in HIV-infected patients: a comparison of Framingham, PROCAM and SCORE risk assessment functions. Int J Clin Pract 2010;64:739-45.

    Article  PubMed  CAS  Google Scholar 

  13. Currier JS, Kendall MA, Henry WK, Alston-Smith B, Torriani FJ, Tebas P, et al. Progression of carotid artery intima-media thickening in HIV-infected and uninfected adults. AIDS 2007;21:1137-45.

    Article  PubMed  Google Scholar 

  14. Grunfeld C, Delaney JA, Wanke C, Currier JS, Scherzer R, Biggs ML, et al. Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study. AIDS 2009;23:1841-9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, et al. Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 2004;109:1603-8.

    Article  PubMed  Google Scholar 

  16. Burdo TH, Lo J, Abbara S, Wei J, DeLelys ME, Preffer F, et al. Soluble CD163, a novel marker of activated macrophages, is elevated and associated with noncalcified coronary plaque in HIV-infected patients. J Infect Dis 2011;204(8):1227-36.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Post WS, Budoff M, Kingsley L, Palella FJ Jr, Witt MD, Li X, et al. Associations between HIV infection and subclinical coronary atherosclerosis. Ann Intern Med 2014;160:458-67.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Subramanian S, Tawakol A, Burdo TH, Abbara S, Wei J, Vijayakumar J, et al. Arterial inflammation in patients with HIV. JAMA 2012;308:379-86.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Wever Pinzon O, Silva Enciso J, Romero J, Makani H, Fefer J, Gandhi V, et al. Risk stratification and prognosis of human immunodeficiency virus-infected patients with known or suspected coronary artery disease referred for stress echocardiography. Circ Cardiovasc Imaging 2011;4:363-70.

  20. Mora S. Nonfasting for routine lipid testing: from evidence to action. JAMA Intern Med 2016;176:1005-6.

    Article  PubMed  Google Scholar 

  21. Bangalore S, Gopinath D, Yao SS, Chaudhry FA. Risk stratification using stress echocardiography: incremental prognostic value over historic, clinical, and stress electrocardiographic variables across a wide spectrum of bayesian pretest probabilities for coronary artery disease. J Am Soc Echocardiogr 2007;20:244-52.

    Article  PubMed  Google Scholar 

  22. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007;49:227-37.

    Article  PubMed  Google Scholar 

  23. Navare SM, Mather JF, Shaw LJ, Fowler MS, Heller GV. Comparison of risk stratification with pharmacologic and exercise stress myocardial perfusion imaging: a meta-analysis. J Nucl Cardiol 2004;11:551-61.

    Article  PubMed  Google Scholar 

  24. Ladapo JA, Blecker S, Elashoff MR, Federspiel JJ, Vieira DL, Sharma G, et al. Clinical implications of referral bias in the diagnostic performance of exercise testing for coronary artery disease. J Am Heart Assoc 2013;2:e000505.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Miller TD, Hodge DO, Christian TF, Milavetz JJ, Bailey KR, Gibbons RJ. Effects of adjustment for referral bias on the sensitivity and specificity of single photon emission computed tomography for the diagnosis of coronary artery disease. Am J Med 2002;112:290-7.

    Article  PubMed  Google Scholar 

  26. Lo J. Dyslipidemia and lipid management in HIV-infected patients. Curr Opin Endocrinol Diabetes Obes 2011;18:144-7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. D’Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omede P, Sciuto F, et al. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J 2012;33:875-80.

    Article  PubMed  CAS  Google Scholar 

  28. Boccara F, Mary-Krause M, Teiger E, Lang S, Lim P, Wahbi K, et al. Acute coronary syndrome in human immunodeficiency virus-infected patients: characteristics and 1 year prognosis. Eur Heart J 2011;32:41-50.

    Article  PubMed  Google Scholar 

  29. Boccara F, Teiger E, Cohen A, Ederhy S, Janower S, Odi G, et al. Percutaneous coronary intervention in HIV infected patients: immediate results and long term prognosis. Heart 2006;92:543-4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Ren X, Trilesskaya M, Kwan DM, Nguyen K, Shaw RE, Hui PY. Comparison of outcomes using bare metal versus drug-eluting stents in coronary artery disease patients with and without human immunodeficiency virus infection. Am J Cardiol 2009;104:216-22.

    Article  PubMed  CAS  Google Scholar 

  31. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-7.

    Article  PubMed  Google Scholar 

  32. Kuller LH, Tracy R, Belloso W, De Wit S, Drummond F, Lane HC, et al. Inflammatory and coagulation biomarkers and mortality in patients with HIV infection. PLoS Med 2008;5:e203.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Parikh RV, Scherzer R, Grunfeld C, Nitta EM, Leone A, Martin JN, et al. Elevated levels of asymmetric dimethylarginine are associated with lower CD4+ count and higher viral load in HIV-infected individuals. Atherosclerosis 2013;229:246-52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Perello R, Calvo M, Miro O, Castaneda M, Saubi N, Camon S, et al. Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort. Eur J Intern Med 2011;22:485-8.

    Article  PubMed  CAS  Google Scholar 

  35. Lewden C, Chene G, Morlat P, Raffi F, Dupon M, Dellamonica P, et al. HIV-infected adults with a CD4 cell count greater than 500 cells/mm3 on long-term combination antiretroviral therapy reach same mortality rates as the general population. J Acquir Immune Defic Syndr 2007;46:72-7.

    PubMed  Google Scholar 

  36. Rodger AJ, Lodwick R, Schechter M, Deeks S, Amin J, Gilson R, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS 2013;27:973-9.

    Article  PubMed  CAS  Google Scholar 

  37. Moore RD, Keruly JC. CD4+ cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis 2007;44:441-6.

    Article  PubMed  Google Scholar 

  38. Nash D, Katyal M, Brinkhof MW, Keiser O, May M, Hughes R, et al. Long-term immunologic response to antiretroviral therapy in low-income countries: a collaborative analysis of prospective studies. AIDS 2008;22:2291-302.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ho JE, Scherzer R, Hecht FM, Maka K, Selby V, Martin JN, et al. The association of CD4+ T-cell counts and cardiovascular risk in treated HIV disease. AIDS 2012;26:1115-20.

    Article  PubMed  Google Scholar 

  40. Paiardini M, Muller-Trutwin M. HIV-associated chronic immune activation. Immunol Rev 2013;254:78-101.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Hofmann U, Frantz S. Role of lymphocytes in myocardial injury, healing, and remodeling after myocardial infarction. Circ Res 2015;116:354-67.

    Article  PubMed  CAS  Google Scholar 

  42. Meng X, Yang J, Dong M, Zhang K, Tu E, Gao Q, et al. Regulatory T cells in cardiovascular diseases. Nat Rev Cardiol 2016;13:167-79.

    Article  PubMed  CAS  Google Scholar 

  43. Tang TT, Yuan J, Zhu ZF, Zhang WC, Xiao H, Xia N, et al. Regulatory T cells ameliorate cardiac remodeling after myocardial infarction. Basic Res Cardiol 2012;107:232.

    Article  PubMed  Google Scholar 

Download references

Disclosure

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA

    Matthew J. Feinstein MD

  2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, Suite 1400, Chicago, IL, 60611, USA

    Matthew J. Feinstein MD & Donald M. Lloyd-Jones MD, ScM

  3. Department of Medicine, Beth Israel Deaconness Medical Center, Boston, MA, USA

    Brian Poole MD

  4. Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron, Suite 3-150, Chicago, IL, 60611, USA

    Pedro Engel Gonzalez MD

  5. Northwestern Medicine Enterprise Data Warehouse, Chicago, IL, 60611, USA

    Anna E. Pawlowski MBA & Daniel Schneider MS

  6. Division of Cardiovascular Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA

    Tim S. Provias MD

  7. Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Suite 3-150, Chicago, IL, 60611, USA

    Frank J. Palella MD & Chad J. Achenbach MD MPH

Authors
  1. Matthew J. Feinstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Poole MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pedro Engel Gonzalez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna E. Pawlowski MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Schneider MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tim S. Provias MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Frank J. Palella MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chad J. Achenbach MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Donald M. Lloyd-Jones MD, ScM
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew J. Feinstein MD.

Additional information

American Heart Association 16FTF31200010 (PI: Feinstein); National Institutes of Health P30AI117943 [PI: D’Aquila (Center for AIDS Research Pilot Grant); Investigators: Feinstein, Achenbach, Lloyd-Jones].

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 205 kb)

Supplementary material 2 (DOCX 11 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feinstein, M.J., Poole, B., Engel Gonzalez, P. et al. Differences by HIV serostatus in coronary artery disease severity and likelihood of percutaneous coronary intervention following stress testing. J. Nucl. Cardiol. 25, 872–883 (2018). https://doi.org/10.1007/s12350-016-0689-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-016-0689-7

Keywords

Search

Navigation